title: Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Recent guidelines suggest lowering the target blood pressure for patients with chronic kidney disease, although the strength of evidence for this suggestion has been uncertain. We sought to assess the renal and cardiovascular effects of intensive blood pressure lowering in people with chronic kidney disease.
  
  
  METHODS
  We performed a systematic review and meta-analysis of all relevant reports published between 1950 and July 2011 identified in a search of MEDLINE, Embase and the Cochrane Library. We included randomized trials that assigned patients with chronic kidney disease to different target blood pressure levels and reported kidney failure or cardiovascular events. Two reviewers independently identified relevant articles and extracted data.
  
  
  RESULTS
  We identified 11 trials providing information on 9287 patients with chronic kidney disease and 1264 kidney failure events (defined as either a composite of doubling of serum creatinine level and 50% decline in glomerular filtration rate, or end-stage kidney disease). Compared with standard regimens, a more intensive blood pressure-lowering strategy reduced the risk of the composite outcome (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68-0.98) and end-stage kidney disease (HR 0.79, 95% CI 0.67-0.93). Subgroup analysis showed effect modification by baseline proteinuria (p = 0.006) and markers of trial quality. Intensive blood pressure lowering reduced the risk of kidney failure (HR 0.73, 95% CI 0.62-0.86), but not in patients without proteinuria at baseline (HR 1.12, 95% CI 0.67-1.87). There was no clear effect on the risk of cardiovascular events or death.
  
  
  CONCLUSIONS
  Intensive blood pressure lowering appears to provide protection against kidney failure events in patients with chronic kidney disease, particularly among those with proteinuria. More data are required to determine the effects of such a strategy among patients without proteinuria.
authors.affiliation: The George Institute for Global Health, The University of Sydney, Sydney, Australia.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.forename: Parya
authors.initials: P
authors.lastname: Ehteshami
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Celine
authors.initials: C
authors.lastname: Foote
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wang
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents